RESUMO
Background: The day after COVID-19 quarantine started, we initiated patient care through Tele-dermatology. Aim: To report the experience of the implementation of Telemedicine in dermatology and to assess its impact on the number of dermatological visits compared with the pre-pandemic period. Material and methods: The study was conducted between March 27th, 2020, and April 30th, 2020. All patients submitted clinical images of their skin condition via secure email before the telemedicine visit. All telemedicine visits were conducted using the Zoom video conferencing platform. Patient demographics and medical history were recorded. If the dermatologist was unable to reach a diagnosis, the patient was sent for an in-person visit, skin biopsy, or additional laboratory workup. Results: We recorded 1,357 Tele dermatology visits from 1,222 patients aged 29 ± 18 years (38% males). Visits increased from 104 to 298 from the first to the last week, corresponding to 17% of the patient volume seen before the pandemic (1,709 in-person patients/week). A preliminary diagnosis was made in 95% of cases. Ninety percent of patients sent photos. Fifty eight percent of cases were chronic diseases, and were classified as inflammatory in 68%, infectious in 15%, neoplastic/tumoral in 7%, or other conditions in 11%. Less than 1% of these visits were COVID-19 related. Conclusions: In this prospective study of Tele-dermatology lasting five weeks, a preliminary diagnosis could be made in approximately 95% of cases and in the first five weeks of implementation, a volume of consultations equivalent to 17% of those made in the pre-pandemic period was carried out. Therefore, Tele-dermatology can be implemented quickly and successfully in practices when healthcare access is limited.
RESUMO
Tungiasis is a cutaneous ectoparasitosis caused by the sand flea Tunga penetrans whose higher prevalence occurs in South America, the Caribbean and Sub-Saharan Africa. It is clinically characterized by a papular lesion, either single or multiple, with a whitish halo and a brown-black central core, most of them localized on the feet. The lesions can be painful and itchy with the most common complication being bacterial superinfection of the skin. We report three cases of Chilean patients who presented skin lesions suggestive of tungiasis on their return from areas of high prevalence of the disease. The diagnosis is made by the clinical features of lesions in a patient from an endemic zone. Standard treatment consists of surgical extraction of the flea followed by application of a topical antibiotic and a tetanus prophylaxis. Prevention of the infestation is essential and includes the use of closed footwear and repellents.
La tungiasis es una ectoparasitosis cutánea causada por la pulga Tunga penetrans, prevalente en Sudamérica, el Caribe y África Subsahariana. Clínicamente se caracteriza por la formación de pápulas, únicas o múltiples, con un halo blanquecino translúcido y una región central pardo-negruzca, frecuentemente localizadas en los pies. Las lesiones pueden cursar con prurito o dolor leve, siendo la sobreinfección bacteriana la complicación más frecuente. Se comunican tres casos clínicos de chilenos que viajaron a zonas de alta prevalencia de tungiasis y que a su regreso presentaron lesiones dérmicas sugerentes de la enfermedad. El diagnóstico se realizó en base a las características clínicas de las lesiones en un paciente proveniente de zonas endémicas. El tratamiento de elección es la extracción quirúrgica de la pulga seguido del uso de antimicrobianos tópicos y la vacunación antitetánica. La prevención es esencial con el uso de calzado cerrado y repelentes.
Assuntos
Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Tungíase/diagnóstico , Chile , Viagem , Tungíase/cirurgiaRESUMO
La psoriasis es una enfermedad sistémica que puede ocurrir de múltiples formas durante el embarazo, con severidad variable, incluso con formas que amenazan la vida. Las variantes severas se han asociado a mayores riesgos maternos y fetales, y la mayor parte de los tratamientos tópicos y sistémicos disponibles están contraindicados durante el embarazo por el riesgo de toxicidad fetal. Los tratamientos de primera línea son los emolientes y los corticoides tópicos de baja-moderada potencia y en casos severos la fototerapia nbUVB es el tratamiento de elección. En pacientes con formas muy severas y refractarias otras alternativas de tratamiento son la ciclosporina, los corticoides sistémicos y los agentes biológicos, especialmente los anti-TNF-α, sin embargo, la información disponible sobre el uso de estas moléculas en embarazadas es muy limitada, y sólo deberían considerarse en casos muy seleccionados. El impétigo herpetiforme es una forma propia de psoriasis pustular severa durante el embarazo y las principales alternativas terapéuticas son la inducción del parto o el uso de corticoides sistémicos.
Psoriasis is a systemic disease that can be present during pregnancy in different clinical forms and variable severity; some forms can be life threatening. Severe clinical forms are associated with greater maternal and fetal risks, and topical and systemic treatments available are mainly contraindicated during pregnancy because of fetal toxicity risks. First line treatments are emollients and low-medium potency topical steroids; in severe cases nUVB phototherapy is the preferred treatment. In patients with more severe and recalcitrant clinical forms cyclosporine, systemic steroids and biologics agents specially anti-TNF-α are the options. Nevertheless the available information of the use of these treatments in pregnant women is limited and these drugs should be considered only in very special cases. Herpetiformis impetigo is a proper form of severe pustular psoriasis in pregnancy and the treatments for this entity should be delivery induction or systemic steroids.